Abstract

New robotic systems have recently emerged to assist with peripheral lung access, but a robotic system for rigid bronchoscopy has yet to be developed. We describe a new robotic system that can deliver thin robotic manipulators through the ports of standard rigid bronchoscopes. The manipulators bend and elongate to provide maneuverability of surgical tools at the endoscope tip, without endoscope motion. We describe an initial feasibility study on the use of this system to bronchoscopically treat a central airway obstruction (CAO). CAO is prevalent and can be life-threatening in patients with large tumors, and conventional rigid bronchoscopic treatments place patients at risk of complications including broken teeth, neck trauma and damage to oropharyngeal structures due to significant forces induced by bronchoscope tilting and manipulation. In this study, we used an ex vivo ovine airway model to demonstrate the ability of a physician using the robotic system to efficiently remove tissue and restore the airway. Pre- and post-operative CT scans showed that the robot was able to reduce the degree of airway obstruction stenosis from 75 to 14% on average for five CAO resections performed in an ex vivo animal model. Using cadaver experiments, we demonstrated the potential of the robotic system to substantially reduce the intraoperative forces applied to the patient’s head and neck (from 80.6 to 4.1 N). These preliminary results illustrate that CAO removal is feasible with our new rigid bronchoscopy robot system, and that this approach has the potential to reduce forces applied to the patient due to bronchoscope angulation, and thereby reduce the risk of complications encountered during CAO surgery.

中文翻译：

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用于刚性支气管镜检查的同心管机器人系统：中央气道阻塞清除的可行性研究

摘要

最近出现了新的机器人系统来辅助周围肺部进入，但是用于刚性支气管镜检查的机器人系统尚未开发。我们描述了一种新的机器人系统，该系统可以通过标准刚性支气管镜的端口输送薄型机械手。操纵器弯曲并伸长以提供在内窥镜尖端处的手术工具的可操纵性，而无需内窥镜运动。我们描述了使用该系统以支气管镜治疗中央气道阻塞（CAO）的初步可行性研究。CAO在患有大肿瘤的患者中普遍存在并且可能危及生命，传统的硬支气管镜治疗由于支气管镜倾斜和操作所产生的巨大力量而使患者面临并发症的风险，包括牙齿折断，颈部创伤和口咽结构损坏。离体绵羊气道模型可以证明医师使用机器人系统有效去除组织并恢复气道的能力。术前和术后CT扫描显示，在离体进行的5次CAO切除术中，该机器人能够将气道阻塞狭窄的平均程度从75％降低至14％动物模型。通过尸体实验，我们证明了机器人系统显着降低施加在患者头部和颈部的术中力（从80.6到4.1 N）的潜力。这些初步结果表明，使用我们的新型刚性支气管镜机器人系统可以去除CAO，并且这种方法有可能减少由于支气管镜成角度而施加在患者身上的力，从而降低CAO手术中发生并发症的风险。